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OR I G I NAL ART I CLE
Efficacy of long-term low-dose macrolide therapy in preventing early
recurrence of nasal polyps a er endoscopic sinus surgery
Anastasia Varvyanskaya, MD and Andrey Lopatin, MD, Dr Med Sci
Background:
This study assessed efficacy of clarithromycin
“long-term” macrolide therapy as an adjunct to mainte-
nance therapy with nasal corticosteroids to prevent recur-
rence of nasal polyps (NP) a er functional endoscopic si-
nus surgery (FESS).
Methods:
A total of 66 patients with chronic rhinosinusitis
and bilateral NP were randomized into 3 study arms, 22 pa-
tients in each arm. A er FESS, patients in the first and sec-
ond groups were treated with clarithromycin 250 mg/day
for 12 and 24 weeks, respectively, whereas patients in the
third group did not receive any clarithromycin. Patients in
all 3 groups received maintenance therapy with mometa-
sone furoate 400
μ
g/day. Patient assessment was con-
ducted before the surgery and 6, 12, and 24 weeks af-
ter surgery, using a visual analogue scale (VAS), 20-item
SinoNasal Outcome Test (SNOT-20), acoustic rhinometry,
rhinomanometry, saccharin transit time, nasal endoscopy,
computed tomography (CT) of paranasal sinuses, and mea-
surement of the level of eosinophil cationic protein (ECP)
in their nasal secretions.
Results:
The study confirmed efficacy of “long-term”
macrolide therapy, resulting in significant improvement of
all parameters except acoustic rhinometry and VAS in both
clarithromycin groups as compared to the control. Concen-
tration of ECP in the nasal secretions increased dramat-
ically a er surgery, then returned to baseline levels a er
12 and 24 weeks of treatment with clarithromycin. In the
control group, ECP level continued to increase and was
significantly higher at the endpoint. Both groups with clar-
ithromycin showed significantly be er endoscopic and CT
scores than the control group at the end point.
Conclusion:
“Long-term” low-dose clarithromycin
250 mg/day is able to control eosinophilic inflammation
and prevent early relapse of NP a er FESS.
C
2014 ARS-
AAOA, LLC.
Key Words:
chronic rhinosinusitis; endoscopic sinus surgery; medical
therapy of chronic rhinosinusitis; computed tomography;
SNOT-20
How to Cite this Article
:
Varvyanskaya A, Lopatin A. Efficacy of long-term low-dose
macrolide therapy in preventing early recurrence of nasal
polyps a er endoscopic sinus surgery.
Int Forum Allergy
Rhinol
. 2014;4:533–541.
C
hronic rhinosinusitis (CRS) often occurs in associa-
tion with nasal polyps (NP). In 1 study CRS with NP
(CRSwNP) was diagnosed in 4% of an entire population
1
and is associated with bronchial asthma (BA) in 7% to
13% of cases.
2
In addition, aspirin-exacerbated respira-
tory disease (AERD) and NP are present in a large number
of patients (ranging, 36-96%).
3
In CRSwNP the predomi-
nate inflammatory cell is the eosinophil, which is found in
Ear, Nose, and Throat (ENT) Clinic, Sechenov First Moscow State
Medical University, Moscow, Russia
Correspondence to: Andrey S. Lopatin, MD, Dr Med Sci., Partizanskayast.
33, bld 1, 55, 121351, Moscow, Russia; e-mail:
lopatin.andrey@inbox.ruPotential conflict of interest: None provided.
Received: 30 July 2013; Revised: 4 February 2014; Accepted: 4 February 2014
DOI: 10.1002/alr.21318
View this article online at
wileyonlinelibrary.com.both the tissue and in the airway mucus in almost all pa-
tients with CRSwNP. Although the role of infection (neu-
trophilic inflammation) has been investigated it does not
seem to be a primary factor in the development of CR-
SwNP although CRSwNP is associated with BA. Allergy
seems to be a comorbid condition and not a primary factor
in the development of CRSwNP.
4
At present, neither med-
ical nor surgical treatment can ensure permanent control
or enduring cure. Currently the only proven treatment for
effective control of CRSwNP is topical nasal steroid sprays
with or without systemic glucocorticosteroids (GCS). Re-
current CRSwNP is not always prevented even with sys-
temic GCS and the side effects can be serious, including
cataracts and vertebral collapse.
5
Because disease control
can be difficult even with systemic GCS we decided to
study treatment with “long-term” therapy (3-6 months and
more) using low dose macrolide antibiotics. Apparently
International Forum of Allergy & Rhinology, Vol. 4, No. 7, July 2014
Reprinted by permission of Int Forum Allergy Rhinol. 2014; 4(7):533-541.
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